Sterilisation

Background and Counselling

  • It is important to explain the procedure clearly, outline the risks, irreversibility etc
  • It is good practice to involve both partners in the explanation/consent process
  • Special circumstances to consider include
    • Young people (particularly < 30), individuals without children or single child families- will they regret the decision; make sure that their family is complete; consider relationship stability
    • Sterilisation (vasectomy) during pregnancy- it is better to wait for pregnancy to complete prior to sterilisation (consider risk of foetal loss)
    • Sterilisation with termination of pregnancy- consider influencing factors related to the choice (is the decision impaired by grief/undue guilt)
      • make sure to counsel at least 1 week prior to the procedure (more if possible) to ensure this is the patient’s wishes
  • Make sure to counsel both men and women about alternative contraceptive methods where appropriate (particularly long-acting reversible methods)

Male

  • Vasectomy
    • Failure rate – 1:2000
    • Simple procedure, can be performed under local anaesthetic, go home after a few hours
    • Doesn’t work immediately
    • Semen analysis needs to be performed twice following a vasectomy before a man can have unprotected sex (usually at 16 and 20 weeks)
      • Contraception should be used for at least 8 weeks following
      • Unprotected sex should really only be started once given the all clear
    • Complications include:
      • bruising/haematoma; infection; sperm granuloma; chronic testicular pain (affects between 5-30% of men)
    • Can be reversed (success rate is ~55% if performed within 10 years and ~25% if longer)
      • Not routinely available on NHS

Female

  • Many different techniques
    • Hysteroscopic tubal occlusion (blockage/implants)
    • Laparoscopic tubal occlusion (Filshie clips or rings)
    • Salpingectomy
  • Failure rate higher than male (1:200)
  • Usually a longer procedure- laparoscopy requires general anaesthetic which has risks and complications etc
  • Complications include
    • Increased risk of ectopic if sterilisation fails
    • Risks of GA etc
    • Increased risk of hysterectomy in the future (reason unknown)
  • Filshie clips/rings can be reversed but success rate is 50-60% (again, not routine on NHS)

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